Start with what coverage you already have

Before you compare Medicare plans, find out whether you are already covered by an employer or union health plan, or by Veterans Affairs. If you have coverage through your current job or a former employer, you may not need to enroll in Medicare right away — but you still have a important date to join without penalties. If you are covered by the VA, Medicare may duplicate that coverage rather than improve it.

Call your current insurance company or your HR department and ask: "Does this plan coordinate with Medicare, or does Medicare become primary when I turn 65?" Write down the answer. This one fact changes which Medicare plan makes sense for you.

If you have no current coverage, or if your coverage ends when you turn 65, you will choose from three main paths: Original Medicare with a supplement, a Medicare Advantage plan, or a Medicare Part D prescription plan. Each path has different costs, different doctors you can see, and different out-of-pocket limits.

Key Takeaways

  • Original Medicare covers hospital and doctor visits nationwide but requires you to buy a separate supplement plan to cap your costs, and a separate prescription drug plan.
  • Medicare Advantage plans bundle hospital, doctor, and prescription coverage in one plan, usually with lower premiums but a network of doctors you must use.
  • Your choice depends on whether you prefer predictable costs (supplement) or lower premiums (Advantage), and whether you have doctors you must keep seeing.
  • You can change plans only during the annual enrollment period from October 15 to December 7, or if you have a may have access to life event like moving or losing coverage.
  • The Medicare Plan Finder tool on Medicare.gov shows you plans available in your zip code, what they cost, and which doctors and pharmacies are in each network.

Understand the three main paths

Original Medicare is run by the federal government. It covers hospital stays (Part A) and doctor visits (Part B) at any hospital or doctor in the country that accepts Medicare. You pay a monthly premium for Part B, a deductible when you use it, and then a percentage of the cost (called coinsurance). There is no yearly cap on what you pay out of pocket — you could spend thousands in a single year. Most people who choose Original Medicare also buy a Medigap supplement plan from a private insurance company. The supplement pays the deductible and coinsurance that Original Medicare does not cover. You also need a separate Part D prescription drug plan from a private company.

Medicare Advantage (also called Part C) is sold by private insurance companies. It bundles hospital, doctor, and prescription coverage into one plan. Premiums are often lower than Original Medicare plus a supplement, and many plans have no monthly premium at all. But you must use doctors and hospitals in the plan's network, except in emergencies. If you see a doctor outside the network, you pay the full cost. Most Advantage plans have a yearly out-of-pocket limit — once you hit it, the plan pays everything else for the rest of the year. This predictability appeals to people who expect high medical costs.

A third option is Original Medicare with no supplement. This is the cheapest upfront but leaves you exposed to unlimited costs. It is rarely recommended unless your income is very low and you may have access to for Medicaid to fill the gaps.

Decide whether you need a specific doctor or hospital

Call your current doctors and ask whether they accept Medicare and whether they are in the network of the Advantage plans you are considering. If your doctor does not accept Medicare at all, Original Medicare will not help you keep seeing them — you would have to pay out of pocket. If your doctor is not in a specific Advantage plan's network, that plan is not a good fit for you.

If you have a doctor you have seen for years and trust, and that doctor is in an Advantage plan's network, Advantage may save you money. If you see many specialists or if your doctors are spread across different networks, Original Medicare with a supplement gives you more freedom to keep all of them.

Also ask your doctors' offices: "Do you have a preferred Medicare plan?" Some practices have relationships with specific Advantage plans and can help you navigate them. Others will tell you they prefer patients on Original Medicare because there are fewer restrictions on what they can do.

Compare costs the way they actually work

Do not compare plans by premium alone. A plan with a zero premium can cost you far more in a year than a plan with a $200 monthly premium, depending on how much medical care you use.

For Original Medicare with a supplement, add up: the Part B premium (currently $164.90 per month for most people, but higher if your income is above a certain level), the supplement premium (ranges from roughly $100 to $300 per month depending on the plan letter and your state), and the Part D prescription plan premium (ranges from $7 to $100+ per month). Then add the Part B deductible ($240 in 2024) and any copays or coinsurance for services. Most people spend $300 to $500 per month total.

For Medicare Advantage, add up: the monthly premium (often $0 to $50), the annual deductible (often $0 to $500), copays for doctor visits and prescriptions, and coinsurance for hospital stays. Most plans cap your total out-of-pocket costs at $6,700 to $8,000 per year. If you rarely see a doctor, Advantage is cheaper. If you have chronic conditions and see doctors often, you may hit the out-of-pocket cap and then pay nothing more for the rest of the year.

Use the Medicare Plan Finder at Medicare.gov. Enter your zip code, your doctors' names, and the medications you take. The tool shows you every plan available to you, the monthly premium, the deductible, copays for your specific doctors and drugs, and your estimated yearly cost based on your current use. This is the only way to compare accurately.

Know when you can switch plans

You can change Medicare plans during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect January 1. If you miss this window, you are locked into your plan for the rest of the year.

You can also change plans if you have a may have access to life event: you move out of your plan's service area, you lose other health coverage, you become may be able to access for Medicaid or Extra Help (a program that pays for prescriptions), or you are in a Medicare Advantage plan and your plan is being discontinued. You have 60 days from the event to make a change.

If you enroll in Medicare for the first time, you have a 7-month window centered on your 65th birthday month to join without a penalty. After that window closes, you pay a permanent penalty if you wait to enroll.

Use Medicare.gov tools to narrow your choices

Go to Medicare.gov and click "Find Care Providers" to search for doctors by name and see which plans they are in. Click "Find Pharmacies" to check whether your pharmacy is in each plan's network and what your copay would be for each of your medications.

The Medicare Plan Finder is the main tool. It shows you plans available in your zip code, the premium and deductible for each, copays for specific services, and your estimated yearly cost. You can filter by plan type (Original Medicare, Advantage, or prescription-only), by whether you want a $0 premium, or by specific features like dental or vision coverage.

Read the plan's "Summary of Benefits and Coverage" document before you enroll. This is a standardized form that shows exactly what the plan covers, what you pay, and what it does not cover. It is dense, but it is the only place to find details about things like physical therapy limits or whether the plan covers hearing aids.

Ask your doctor or pharmacist for a second opinion

Your doctor knows your health better than any online tool does. Ask: "Which Medicare plans do you recommend for patients like me?" or "Would you recommend Original Medicare or Advantage for someone with my conditions?" Many doctors have seen patients struggle with specific Advantage plans' prior authorization requirements (where the plan makes you get approval before a treatment) or network restrictions.

Your pharmacist can tell you whether your medications are on each plan's formulary (the list of covered drugs) and what your copay would be. Some plans charge $5 for a common drug and $100 for another. Your pharmacist can spot these differences quickly.

If you are unsure after comparing plans yourself, call your State Health Insurance information Program (SHIP). SHIP is a free counseling service in every state. Counselors are trained to compare plans and can walk you through the decision over the phone. Find your state's SHIP at shiptalk.org.

Frequently Asked Questions

Can I switch from Medicare Advantage to Original Medicare anytime?

No. You can switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event like moving or losing coverage. Outside these windows, you are locked in. If you switch from Advantage to Original Medicare, you have 63 days to buy a Medigap supplement, or insurers can deny you or charge more based on your health.

What if I cannot afford any Medicare plan?

If your income is below 150% of the federal poverty level, you may may have access to for Medicaid, which covers costs that Medicare does not. If your income is between 150% and 200% of poverty, you may may have access to for Extra Help, which pays for Part D prescriptions. Contact your state Medicaid office or call 1-800-MEDICARE to learn what you may have access to for based on your income and assets.

Do I have to enroll in Part D if I do not take many medications?

If you choose Original Medicare, yes — you should enroll in Part D even if you take no medications now. If you wait and then need a prescription later, you pay a permanent penalty for every month you delayed. The penalty is about 1% of the national average Part D premium per month of delay. If you choose Medicare Advantage, prescription coverage is included, so you do not buy Part D separately.

What if my plan is discontinued?

Insurance companies sometimes stop offering a plan in your area. If this happens, Medicare sends you a notice and you have until the end of the year to choose a new plan. You can switch to any other plan available in your zip code, including Original Medicare, without waiting for the Annual Enrollment Period.

How do I know if a plan covers my specific medications?

Each plan publishes a formulary — the official list of covered drugs. Go to the plan's website or call the plan's customer service number and ask for the formulary. Search for each of your medications by name. The formulary also shows what tier (copay level) each drug is on. Tier 1 drugs are cheapest; Tier 5 drugs are most expensive.